动态心电图窦性心律震荡在冠心病高危患者诊断中的价值

The clinical value of Holter heart rate turbulence in the diagnosis of patients at high risk for coronary heart disease

目的 探讨动态心电图窦性心律震荡在冠心病高危患者诊断中的临床价值.方法 对110例冠心病疑似患者行冠状动脉造影（CAG）检查,按CAG检查结果分为CAG阳性组和CAG阴性组,其中阳性组67例,阴性组43例.两组患者均行动态心电图检查,对心律震荡、心率变异性进行分析.去除房颤、房扑干扰及伪差,选择符合条件的室性期前收缩.计算HRT的两个参数,震荡初始值（TO）和震荡斜率值（TS）.结果 阳性组TO平均值为（0.36＆#177;0.15）％,TS平均值（1.98＆#177;0.52） ms/RR；阴性组rO平均值为（-0.87＆#177;0.36）％,TS平均值为（4.83＆#177;0.65） ms/RR,两组差异有统计学意义（t=1.953、1.976,均P＜0.05）.随访1年后,阳性组死亡9例（13.44％）,阴性组死亡2例（4.65％）,差异有统计学意义（x2=5.476,P＜0.05）.结论 动态心电图窦性心律震荡有助于早期发现冠心病高危患者,对提高患者生存率具有重要的临床意义.该方法简便、价廉、有效、临床可操作性强,值得在临床中推广.

Objective To explore the clinical value of Holter heart rate turbulence in diagnosis of patients at high risk for coronary heart disease.Methods 110 patients with suspected coronary artery disease,according to the results of coronary angiography （CAG）,were divided into CAG positive group （67 cases） and CAG negative group （43 cases）.Heart rate turbulence and heart rate variability were analyzed in two groups.The atrial fibrillation,atrial flutter,and pseudo-differential interference were removed,the qualified ventricular contraction was selected.Two parameters of HRT,the initial shock value （TO） and turbulence slope value （TS） were calculated.Results The average value of TO and TS was （0.36 ＆#177; 0.15） %,（1.98 ＆#177; 0.52） ms/RR in positive group,those in the negative group were （-0.87 ＆#177; 0.36） % and （4.83 ＆#177; 0.65） ms/RR,there were statistically significant differences between two groups （t =1.953,1.976,all P 〈 0.05）.After 1 year follow-up,9 cases （13.44%） died in positive group,2 cases （4.65%） died in negative group,the difference was statistically significant （x2 =5.476,P 〈 0.05）.Conclusion The heart rate turbulence with dynamic cardiogram can help to early diagnose the patients at high risk of coronary heart disease.It was important to improve the survival rate of patients.The method is simple,inexpensive,effective,which is worth promoting in the clinic.